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People wait in line to get tested for COVID-19 at a temporary screening center in Seoul on July 22. (Yonhap News)

Lee Jong-kyu

By Lee Jong-kyu, senior staff writer

In October 2020, Harvard University professor Martin Kulldorff and two other infectious disease experts issued a declaration in the small Massachusetts town of Great Barrington, calling for a change in approach toward the COVID-19 pandemic.

Lockdown policies, they argued, would have a negative long-term impact on public health, causing a collective deterioration in cardiovascular ailments, a drop in cancer diagnoses, and worsening mental health.

On this basis, they called for the lockdowns to be lifted, adding that we should focus on protecting older adults and other high-risk populations and make it our goal to minimize the fatality rate and general social repercussions. They also suggested that the younger people at less risk of dying should return to daily life and acquire immunity through “natural infection.”

This “Great Barrington Declaration” ended up touching off a major debate over the use of lockdowns as a disease control measure.

About 10 days later, the international medical journal The Lancet published a piece rebutting the declaration. Credited to 79 European and American scientists and medical experts, it argued that the strategy of working to achieve “herd immunity” while providing “focused protection” to high-risk groups was a “dangerous fallacy unsupported by scientific evidence.”

Their argument was that if the infection spread among young people, this stood to increase the infection and fatality rates for the entire population and potentially trigger a healthcare system collapse. They also pointed out the practical difficulties attendant on selecting and protecting high-risk groups.

In their view, the best way to protect society until vaccines and treatments were available would be to prevent COVID-19 from spreading within the community.

The document became known as the “John Snow Memorandum,” after the infectious disease scholar determined that cholera prevalent in London during the 1850s was a waterborne disease transmitted through contaminated drinking water.

When these declarations were published, the COVID-19 pandemic was spreading so ferociously that the debate ended up drawing little attention. Soon afterward came the announcement of success with vaccine development, and the debate subsided further.

In terms of death tolls and other disease performance metrics, the John Snow side appears to have won a resounding victory. After all, the countries that were lax about prevention before vaccines were available suffered far more grievous losses than the ones who earned gold stars for their prevention efforts.

With vaccination rates rising, the disease control paradigm debate has recently been heating up again. The difference this time is that it isn’t just a debate among experts — we’re seeing countries embarking on what amount to experiments.

The boldest of them all has been the UK. Declaring July 19 to be “Freedom Day,” the UK did away with virtually all its disease prevention regulations. Even with the Delta variant of the virus keeping the daily confirmed case total in the five figures, the country went ahead as scheduled with laying down its disease-fighting arms.

Singapore similarly declared last month that it would be treating COVID-19 as another “seasonal flu.” In other words, it’s shifting its disease control focus from checking the rise in cases to minimizing the number of fatalities and patients with severe symptoms.

These experiments are grounded in high vaccination rates: 68.2% of the British population has received at least one dose (53.2% are fully vaccinated), and 71.2% of Singapore’s population (47.7% fully vaccinated). The mitigation strategy rests on the fact that as the vaccination rates increase, the rates of fatality and severe symptoms decline.

But it’s still too early to tell if the experiments will succeed. Many are particularly concerned about the UK, which moved quite quickly to tear down its disease control walls.

In a recent correspondence published in the Lancet, around 120 scientists — including many of the same ones who spearheaded the John Snow Memorandum — criticized the UK’s decision as “dangerous and premature.”

“Proportionate mitigations will be needed to avoid hundreds of thousands of new infections until many more are vaccinated,” they said. Many of the UK’s own disease control specialists have also been warning of a possible explosion in infections.

Meanwhile, after Singapore’s declaration a month ago that it planned to “coexist” with the virus, it has been tightening the disease control reins once again over the past few days in response to several cluster infections. This just goes to show how perilous the “with corona” strategy is.

Here in Korea, we’ve also heard people saying that we ought to adopt our own “with corona” disease control paradigm. As vaccinations of high-risk groups have brought down the rates of fatalities and severe symptoms, these people are questioning how long we should continue implementing intensive social distancing measures with high social costs.

Underlying this argument is the idea that ending COVID-19 is not a realistic option. We shouldn’t dismiss this position as being too casual, but we shouldn’t rush into any decisions.

We need to transition toward a sustainable disease control system, but nothing in this world is free. There has to be a societal consensus on our level of disease prevention, and we need to adjust our healthcare system to a changed set of circumstances.

Failure to adequately prepare could lead to major chaos. We need to start making careful preparations for an orderly “exit strategy.”

Please direct comments or questions to [english@hani.co.kr]